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Nasal Fx/Septo/ Rhino

Sherry Posted Wed 11th of May, 2011 17:24:28 PM

Through the left nares, a mucoperichondrial incision was made anteriorly and the dissection went posteriorly and superiorly. Superiorly, the cartilage was removed. The inferior aspect of the septum had a large spur tht was both bony and cartilaginous. It was isolated and removed using an osteotome. The cartilaginous portion of this was used to reconstruct the nasal septum superiorly. The mucoperichondrial flaps were closed using 4-0 chromic. An open rhinoplasty type exposure was used to examine the nasal dorsum. The upper lateral cartilages were dropped inferiorly due to lack of support from the septum. There was a large fracture with collapse of some of the bony dorsum into the airway on the right side. The Cottle elevator was used to carefully elevate the bone back into the dorsum on the right side by engaging the dorsum on the free edge of the bony dorsum. The upper lateral cartilages were reattached. Cartilage from the septum was used to reinforce the superior aspect of the septum and the distal one-half of the dorsum. The turbinates were outfractured to help with the airway. Doyle splints were placed and secured across the septum. The nose was taped and a cast was placed.
He says he did a 21335. It sounds more extensive to me.

SuperCoder Answered Wed 11th of May, 2011 18:02:47 PM

Eventhough it sounds more extensive, I would prefer to go 21335 and I believe it is the accurate code in this scenario. Of course RVU value is high compare to other three open treatment of nasal fracture codes (i.e.21325,21330,&21336)

Sherry Posted Wed 11th of May, 2011 18:46:57 PM

Thank you for your input. All the cartilage reconstruction threw me off.

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